Aim. This work documents our experience over the previous 8 years using fibula free flap for reconstruction of large mandibular defects. The etiology of the bone defects included benign and malignant tumors, trauma and osteomyelitis.Methods. Between January 2002 and December 2010, a total of 38 free osteocutaneous fibula flaps have been used in an equal number of patients for reconstruction of the mandible, at the Division of Maxillofacial surgery, San Giovanni Battista Hospital, University of Turin. Malignant pathology was the most common indication for segmental mandibulectomy. Demographics, location of tumor, adyuvant therapies, complications, dental implants were analyzed in all cases. Complications were categorized as major and minor. The data were reviewed to identify flap, donor-site and systemic complications. Clinical and quality of life outcomes were assessed by clinical examination and a questionnaire.Results. Thirty-seven flaps out of 38 were harvested and transplantated successfully. For the free flaps examinated in this work, the overall complication rate was 29%. In the questionnaire 29 patients replied that they had a regular deglutition; most of the patients were satisfied about their speech function (N.=28) as well as their aesthetic appearance, since it was judged to be good by 24 patients. Ten patients out of 38 received dental implants.Conclusions. In our experience the fibula free flap is the most versatile and reliable option for surgical reconstruction of large mandibular defects. It provides a straight and bicortical bone, allows osteotomies and the bone height is suitable for an implant-based prosthetic restoration. The morbidity of lower leg donor site is moderate.